MEDICARE: MR. GLENN PATRICK THURMAN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	10831	NC
2	225100000X	Physical Therapist	2641	NV

General Provider Information

NPI Number	:	1699841049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GLENN PATRICK THURMAN PT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5550 PAINTED MIRAGE RD STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4582
Country	:	US
Telephone Number	:	702-898-7633
Fax Number	:	702-898-6433

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	03/05/2024

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